1. IHE IT Planning Committee Co-Chairs
Interoperability in the Real World, Testing, Success Stories and International
Didi Davis, Eclipsys
Glen Marshall, Siemens
IHE IT Planning Committee Co-Chairs
HIMSS 2005

2. Working Together to Deliver Interoperable Health Information Systems
W W W . I H E . N E T
Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and across Care Settings
HIMSS 2005

3. Standards Alone Are Not Enough
Standards offer generality, ambiguity and alternatives.
We need to manage domain boundaries, with mapping of information flow across those boundaries.
Vendors always have proprietary interests.
The result: Complexity!!
We need uniform guidance for how to implement standards!
HIMSS 2005

4. Connecting Standards to Care
Care providers must work with vendors to coordinate the implementation of standards to meet their needs
Care providers need to identify the key interoperability problems they face
Drive industry to develop and make available standards-based solutions
Implementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions
What is an effective way to establish uniform guidance for how to implement standards ?
HIMSS 2005

5. Need for a Standards Implementation Process
Demand ?
Standards
Standards
Standards
User Projects
Offer
HIMSS 2005

6. What is Integrating the Healthcare Enterprise ?
IHE provides a common framework for passing health information seamlessly:
within the healthcare enterprise
across multiple healthcare enterprises
for local, regional & national health information networks.
IHE is sponsored by healthcare professional associations (ACC, HIMSS, RSNA, etc.).
IHE drives standards adoption to address specific clinical needs.
HIMSS 2005

7. IHE Maturity and Acceptance
More than 100 healthcare vendors worldwide have contributed to IHE and the delivery of ready-to-integrate products to benefit healthcare enterprises of all sizes.
IT professionals & clinicians appreciate IHE’s positive impact now expanded to address:
radiology, cardiology, laboratory
enterprise healthcare IT infrastructures
cross-enterprise healthcare IT infrastructures
HIMSS 2005

8. Understanding the IHE Initiative
IHE has a clear focus
IHE is a healthcare domain-based initiative
IHE creates synergies for interoperability testing across domains
IHE addresses the standards adoption process
IHE is both regional and multi-national
IHE is both user led and vendor driven
HIMSS 2005

9. A Proven Standards Adoption Process
IHE Connect-a-thon Results
Product IHE Integration Statement
IHE Connect-a-thon
Product
With IHE
IHE Demonstration
Easy to
Integrate
Products
IHE Technical Framework
Standards
IHE Integration
Profiles B
Profile A
User Site
RFP
IHE Integration Profiles at the heart of IHE :
Detailed selection of standards and options each solving a specific integration problem
A growing set of effective provider/vendor agreed solutions
Vendors can implement with ROI
Providers can deploy with stability
HIMSS 2005

10. Standards-based Integration
IHE Drives Healthcare
Standards-based Integration
IHE Integration Profile: A well-defined and tested solution to a specific information exchange problem
HIMSS 2005

11. Achievements and expanding scope
Over 100 vendors involved world-wide, 4 Technical Frameworks
27 Integration Profiles, Testing at yearly Connectathons,
Demonstrations at major exhibitions world-wide
To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.
HIMSS 2005

12. IHE Survey Results 92% of respondents were aware of IHE
Potential benefits of IHE 
Improved clinical workflow + access of data = 63%
Benefits of IHE products 
Reduce deployment costs
= 56%
**HIMSS web-based survey in November 2004 – 163 participants
HIMSS 2005

13. IHE: Domain-based for a stepwise approach
Patient Management
Order Management
Labora-
tory
Cardiology
Pharmacy,…..
Radiology
Patient Identifier Linkage, Registries, Security
Electronic Health Record
Other (e.g. Access Control, eHealthWorkflows)
HIMSS 2005

14. IHE (International) Strategic Development Committee
IHE Organizational Structure
Multi-Domain & Multi-National
supervises
reports
IHE (International) Strategic Development Committee
Sponsors Co-Chairs
Global
Interoperability
Delegates
IHE Europe
IHE North America
IHE Asia/Oceania
Regional & National Deployment
National Extensions
IHE Domain-related Planning Committee and Technical Committee
Global Development: Radiology, IT Infrastructure, Cardiology, Lab, etc.
contribute
Participants
HIMSS 2005

15. IHE Process
Users identify desired functionality that require coordination and communication among multiple systems
E.g., departmental workflow, single sign-on, sharing of documents
Find and document standards-based transactions among systems to achieve desired functionality
Apply necessary constraints to eliminate useless wiggle room
Provide process and tools to encourage vendors to implement
MESA software test tools + Connect-a-thon interoperability testing event
Provide tools and education to help users acquire and integrate systems using these solutions
Connect-a-thon results, public demo & Vendor Integration statements
HIMSS 2005

16. IHE Process – 20 month yearly cycle
Development and Deployment
Approved Supplement Scope
Proposed Supplement Scope
Public Comment Intgr-profile
Trial Implementation Intgr-profile
Sponsors announce Connectathon/Demos with set of Implementation Profiles
0 ---
Vendor Participant Registered
Vendor Participants pass Connectathon
Demo & Education Material
Final Integration profile
Vendors release products with IHE Integration Statements
---
HIMSS 2005

17. What IHE is NOT! A standards development organization
Uses established standards (HL7, DICOM, others) to address specific clinical needs
Activity complementary to SDOs, formal relationship with HL7, ISO, DICOM, NCCLS, etc.
Simply a demonstration project
Demos, only one means to the end—adoption
Backed up by documentation, tools, testing, and publication of information
HIMSS 2005

18. Enterprise-wide Healthcare Needs Addressed by IHE
Continuity & Integrity of Patient Information
Improved Patient Safety Through Ubiquitous Access to Data
Clinical Workflow Optimization
Avoidance of Repeating Tasks
Reduction of Data Redundancy
Improving the Patient Care Process
HIMSS 2005

19. IHE IT Infrastructure Profiles
Level / Function
Workstation
Intra- enterprise
Cross- enterprise
Security, Directories
EUA (single sign-on)
ATNA, CT (log & sec. Nodes, date/time)
PWP (personnel directory)
Patient Identity
PSA
(patient synch.)
PDQ (patient query)
PIX (cross- referencing Ids)
EHR
RID (document access)
XDS (documents sharing)
HIMSS 2005

20. Key IHE Concepts Generalized Systems -> Actors
Interactions between Actors -> Transactions
Problem/Solution Scenarios -> Integration Profiles
For each Integration Profile:
the context is described (which real-world problem)
the actors are defined (what systems are involved)
the transactions are defined (what must they do)
Generalized the systems because there are many ways vendors can bundle products.
Some PACS may include a Report Creator, others may not.
Some Modalities may include a Print Composer, others may not.
HIMSS 2005

21. Product XYZ from Vendor T
The Product World…..
Product XYZ from Vendor T
HIMSS 2005

22. The IHE World…. IHE Transaction IHE Transaction IHE Actor IHE Actor
HIMSS 2005

23. Mapping IHE to Products
Product XYZ from Vendor T
Actor
Actor
IHE Transaction
IHE Transaction
IHE Actor
Actor
IHE Actor
IHE Transaction
HIMSS 2005

24. IHE Connectathon Open invitation to all implementers
Advanced testing tools (MESA)
Testing organized and supervised by project management team
Thousands of cross-vendor tests performed
Results recorded and published
HIMSS 2005

25. IHE Connectathons Massive yearly events : 40-50 vendors
>300 engineers
>100 systems
….integrated in 5 days
Vendors do not pass…
until an IHE Project Manager attest it !
HIMSS 2005

26. Integration Statements
HIMSS 2005

27. Leveraging IHE Integration Statements
Vendors
Claim IHE Compliance in an explicit way
Can rely on an objective and thorough specification (IHE Technical Framework)
Willing to accept contractual commitments
Willing to correct “implementation errors”
Buyers
Can compare product integration capabilities
Simplify and strengthen their RFPs
Can leverage a public and objective commitment
Decreased cost and complexity of interface deployment and management
HIMSS 2005

28. Participating and Contributing Vendors America
In white, companies with IHE Committees Chairs (Summer 2004)
Agfa HealthCare
Algotec Systems, Ltd.
Berdy
Camtronics
Canon Medical Systems
Carefx
Cedara Software Corporation
Cerner Corporation
CSIST
Dictaphone
DR Systems
Dynamic Imaging
Eastern Informatics
Eastman Kodak Company
Emageon
Eclipsys
Fujifilm Medical Systems
GE Healthcare
Heartlab
Hitachi Medical Corporation
Hologic, Inc
IDX Systems Corporation
IMCO Technologies
InSiteOne
INFINITT
Konica Minolta
Marotech, Inc.
McKesson Information Solutions
Medcon
Medical Manager Health Systems
Mediface Co., Ltd.
Merge eFilm
Mortara
Procom
Philips Medical Systems
RASNA Imaging Systems
Sectra
Sentillion
Siemens Medical Solutions
Softmedical
Stentor, Inc
StorCOMM, Inc
Swissray International, Inc
Tiani Medgraph AG
Toshiba America Medical Systems
UltraVisual Medical Systems
Vital Images, Inc.
Voxar Limited
WebMD
XIMIS
HIMSS 2005

29. Participating and Contributing Vendors Europe
In white, companies with IHE Committees Chairs (Summer 2004)
AGFA Healthcare
Medical Solutions
Algotec
ARES SA
aycan Digitalsysteme
ConVis
DEDALUS
Dianoema
Eastman Kodak Company
Ebit Sanita
EDL
ELFIN s.r.l.
Engineering Sanità Enti Locali
ESAOTE
ETIAM
Ferrania
Fujifilm
GE Healthcare
GMD
GIE Convergence-Profils
GWI Research
IASI Srl
IdeoPass
Image Device-Cerner Company
INFINITT
INOVIT
McKesson
MED2RAD
MEDASYS SA
Medavis
Medigration GmbH
MEDIMON Ltd.
MEDOS AG
Merge eFilm
METAFORA
Konica Minolta Europe
Omnilab
Philips Medical Systems
Rasna Imaging Systems
RAYPAX INC.
Rogan-Delft
Sago spa
Sectra Imtec AB
Siemens Medical Solutions
Soluzioni Informatiche srl
Stentor Inc.
Swissray Medical AG
Symphonie On Line
Synapsis
TELEMIS S.A.
TIANI MEDGRAPH AG
TOREX GAP Medical
Toshiba Medical Systems
TSI groupe europMedica
VEPRO AG
VISUS Technology Transfer
WAID
XR PARTNER
HIMSS 2005

30. Participating and Contributing Vendors Asia
Japan
AGFA Gevaert Japan
EBM Japan
INFINITT Japan
A&T
Canon
Goodman
Climb Medical Systems
Konica Minolta MG
Shimadzu
SONY
Toshiba Medical Systems
Toyo Technica
Nihon Kohden
Olympus
NEC
Pioneer (Marotech)
Hitachi
Hitachi Medico
Fujitsu
Fuji Film Medical
Yokogawa
Taiwan
INFINITT
Shing Shian
INQ GEN
TEP
Tah Ya
Korea
AGFA Korea
GE Healthcare Korea
INFINITT
LG CNS
Marotech, Inc.
Medical Standard
Peoplenet Communications
Samsung SDS
HIMSS 2005

31. IHE Success Stories highlighting benefits
Bethesda Healthcare Systems
Cleveland Clinic Foundation
Detroit Medical Center
Grossman Imaging Centers
Hôpitaux Universitaires de Genève
Johannes Gutenberg University Hospital
Klinikum Nürnberg, Magic Valley Regional Medical Center
Mayo Clinic Jacksonville
McKay-Dee Hospital
MeritCare Medical System
Montefiore Medical Center
Our Lady Of The Lake Regional Medical Center (OLOL)
US Dept. of Veterans Affairs
VA Puget Sound Health Care System
St. Vincent Hospital and Health Services
Sinlau Hospital
Staedtisches Klinikum Goerlitz
Steinberg Diagnostic Medical
University of Pisa
University of Wisconsin
Warren Hospital
HIMSS 2005

32. IHE Radiology Integration Profiles
Charge Posting
Portable Data for Imaging
NM Image
New
Extensions
Scheduled Workflow -
Presentation of Grouped Procedures
Reporting Workflow
Patient Info. Recon-ciliation
Post-Processing Workflow
Consistent Present- ation of Images
Evidence Docs
Key Image Notes
Simple Image & Numeric Reports
Access to Radiology Information
HIMSS 2005
Basic Security

33. Laboratory IHE Integration Profiles
In Dev.
Laboratory Scheduled Workflow (LSWF)
Completed in 2003
Tests performed by a laboratory for an identified inpatient or outpatient
Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004
Tests performed on point of care or patient’s bedside
Laboratory Patient Information Reconciliation (LPIR) In Process
Tests performed on an unidentified or misidentified patient
Laboratory Code Set Distribution (LCSD) In Process
Sharing the batteries and tests code sets throughout the enterprise
Laboratory Device Automation (LDA) In Process –TI Nov 2004
Pre-analytic process, analysis
and post-analytical treatment
Year one (2003) brought the first integration profile « Laboratory Scheduled Workflow ». This profile supports the most common situation: The tests are placed to and performed by a clinical laboratory on specimens collected from a patient correctly identified in the hospital.
Year two (2004) is expected to complete the framework with four more profiles:
« Laboratory Patient Information Reconciliation » profile provides the messaging to resolve all the exceptional situations: Tests performed on an unidentified patient. Urgent tests performed before the order was generated. Merging of a misidentified patient…
« Laboratory Point Of Care Testing » supports specimen testing on the point of care or on the patient’s bedside, by the care unit staff, under the overall supervision of a clinical laboratory.
« Laboratory Device Automation » describes the messaging between the laboratory automation manager and all the automated devices (analyzers, robotic decappers, centrifuges, conveyors, aliquoters, …).
« Laboratory Code Set Distribution » enables the various actors to rely on a common dictionary of tests and batteries.
Some of these new profiles will be achieved in 2004, some others may need one more cycle.
HIMSS 2005

34. IHE Cardiology 2004-2005 Retrieve ECG for Display
New
Retrieve ECG for Display
Provide high-quality ECG and related reports
to the enterprise and outside in a ready-to-display format
New
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be presented to the requesting user
EchoCardiography Worklflow
Admit, order, schedule, acquire images, notify of completed steps, on fixed and mobile stress echo modalities.
Cardiac Catheterization Workflow
New
Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps.
HIMSS 2005

35. IHE IT Infrastructure 2004-2005
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to create a secured domain.
New
Patient Demographics Query
Personnel White Page
Access to workforce contact information
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be presented to the requesting user
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Identifier Cross-referencing for MPI
Enterprise User Authentication
Provide users a single name and centralized authentication process across all systems
Patient Identifier Cross-referencing for MPI
Map patient identifiers across independent identification domains
Consistent Time
Coordinate time across networked systems
Map patient identifiers across independent identification domains
HIMSS 2005

36. IHE Profiles for RHIOs What is available and what will be added in 2005
Patient Demographics Query
Notification of Document Availability
Notification of a remote provider/ health enterprise
Cross-enterprise User Identity and Accountability
Authentication & Auditing: Basis for Access Control
Imaging Information Content
Format of the Document Content and associated coded vocabulary
For Display Document Content
Format of the Document Content
Lab Results Document Content
Continuity of Care Document Content
and associated coded vocabulary
Patient Identifier Cross-referencing
Map patient identifiers across independent identification domains
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to create a secured domain.
Personnel White Page
Access to workforce contact information
Consistent Time
Coordinate time across networked systems
HIMSS 2005

37. Local & Regional RHIOs Infrastructure and Interoperability
Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution
XDS works with other IHE Integration Profiles:
Audit Trail and Node Authentication (ATNA) and Consistent Time (CT)
Patient Id Cross-referencing (PIX)
Patient Demographics Query (PDQ)
In 2005, IHE plans to finish base set of integration profiles to build regional health networks and interoperable EHRs:
Security: Identity Management+ Accountability
Content Profiles: DICOM, HL7-CDA-R2/CCR, HL7-Lab, PDF.
Notification of Document Availability (with XDS document reference)
HIMSS 2005

38. IHE: RHIOs’ Interoperability Partner
IHE offers a solid technical foundation to establish interoperability for RHIOs.
Standards-based, open, multi-vendor, provider-led.
Yearly progress, validation testing built in, backed by a proven process. Implementation by many vendors.
RHIOs’ technical architects’ needs direct IHE involvement. Policies easier to establish when based on solid IHE Technical Framework, but are beyond IHE’s scope. They remains RHIOs’ responsibility.
HIMSS 2005

39. Experience your HIMSS-Wide Electronic Health Record
Cross-enterprise Showcase Booth
Cardiology Workup
Comprehensive Patient Care
Radiology
Coordinated Patient Evaluation
IT Infrastructure
Vendor Booth
HL7 Demonstration
HIMSS “RHIO” with
IHE-XDS Cross-enterprise doc sharing
15 Vendor Booths
Ambulatory Showcase Booth
Home
PCP
Multispecialty Clinic
Diag Center
HIMSS 2005

40. W W W . I H E . N E T
Thank You Questions ?
HIMSS 2005

41. Working Together to Deliver Interoperable Health Information Systems
W W W . I H E . N E T
Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and across Care Settings
HIMSS 2005